Emergency! Faster Ambulance Response for Sri Lanka

Partnerships are supporting Sri Lanka’s health care providers by strengthening the country’s prehospital ambulance service, which has been overwhelmed by the COVID-19 pandemic. ADB and Japan have targeted a more comprehensive and responsive prehospital service to help Sri Lanka sustain its very good progress in the health care sector in the past decades.

Public Sector–Led Health Care

Sri Lanka has made excellent progress in providing health services to its people in the past decades. In this island-nation of 22 million, the immunization coverage of vaccine-preventable diseases is at 99%, and the maternal and childcare services coverage is also nearly 100%. But its health care system is not without its challenges.

The pandemic that has been overwhelming Sri Lanka’s health care facilities and practitioners since 2020 exacerbated long-standing challenges to the country’s health care system, including the prioritization of secondary and tertiary health care at the expense of primary health care services.

Prehospital Services for Emergency Cases and COVID-19

One essential feature of Sri Lanka’s health care system is its emergency health services or prehospital care. In 2016, the Government of Sri Lanka provided a state-of-the-art prehospital ambulance system—the 1990 Suwa Seriya ambulance service—at no cost to the population at the point-of-service delivery.

The importance of having access to an emergency health service via an ambulance system is well recognized as an essential part of a well-functioning, responsive health system in any country.

With the increasing COVID-19 burden—since May 2021, about 30% of emergency calls were related to COVID-19—the need for a prehospital ambulance service has further increased. The ambulance service has been used exclusively to transport COVID-19 patients from their homes to the nearest hospital or treatment center while providing emergency care services for non-COVID-19 emergencies.

This package of support will boost Sri Lanka’s health care system, with more ambulances and improved hospital facilities.

– Dai-Ling Chen, ADB health specialist and project officer

ADB and the Japan Fund for Prosperous and Resilient Asia and the Pacific (JFPR, previously Japan Fund for Poverty Reduction) have responded to this increased need to support Sri Lanka to improve its prehospital ambulance services.

The Efficiency of Ambulance Services

The current response time of the service is just under 12 minutes on average, much longer than the ideal response time of within 8 minutes. Ambulance response times vary across different districts and provinces. For example, the response times in Colombo (about 10 minutes) are half of those in Badulla (about 20 minutes) for non-COVID-19 cases. For COVID-19 patients, the response time varies between 15 minutes in Jaffna (north) to nearly 1 hour in Badulla (southeast). The burden on ambulances is linked to the lack of adequate ambulances to cover a vast geographic area, the increased support to COVID-19 patients, and special sanitizing protocols.

The ambulance service urgently needs to increase its fleet by 112 ambulances (by nearly 40%, or one ambulance per 50,000 people) to enable the service to respond on time to meet the medical emergencies of COVID-19 patients without compromising its response to other medical and surgical emergencies

“Sri Lanka’s health care system has been severely strained due to COVID-19 and the overall need for a better prehospital system, including more ambulances. This package of support will boost Sri Lanka’s health care system, with more ambulances and improved hospital facilities,” said Dai-Ling Chen, health specialist, ADB.

Japan’s Support

In 2021, ADB approved additional financing for the overarching Health System Enhancement Project, approved in 2018. The project sets out to improve the efficiency, equity, and responsiveness of the primary health care service systems, specifically in the Central, North Central, Sabaragamuwa, and Uva provinces. The additional financing included a grant from the JFPR to help the government-managed prehospital ambulance system become more efficient. The grant will also strengthen the capacity of staff members to maintain a high-quality, effective, and efficient prehospital service under the increasing COVID-19 burden in the country.

Projected Results

The JFPR grant-finance assistance will help improve Sri Lanka’s capacity to detect and treat COVID-19 and manage the ongoing pandemic by providing comprehensive and systematic support to strengthen the prehospital ambulance service.

Specifically for reducing the average response time, the grant will support the expansion of the ambulance fleet by 8%, provide training sessions on infection prevention and control, and train new medical technicians and medical staff working on the ambulance service.

The grant will also reduce turnaround time by improving the receiving secondary and tertiary care hospitals, which will make the existing ambulance service more efficient. Doing this would mean reducing the time lag from patient arrival to initiation of treatment through a collaboration with the Japanese Emergency Medical Service. Additionally, locally appropriate protocols will be developed to create a real-time link between the ambulance and the receiving emergency treatment unit and improve the ambulance staff and center facilities by renovating 20 ambulance stations for 1,990 Suwa Seriya staff located at local police stations.

Reducing the average response and turnaround times of ambulance services to transport COVID-19-positive patients to hospitals without compromising the emergency prehospital services for non-COVID-19 patients will help contain the spread of the virus, lower the health care burden of COVID-19, and restore the normality of pre-pandemic health service delivery.